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Research Proposal

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Natalie Warrick

on 25 March 2015

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Transcript of Research Proposal

Background
Conceptual Framework
Policymakers require guidance about which interventions are most likely to sustain caregivers over the long-term
Rationale
RESEARCH
QUESTIONS

160,792 Canadians live in LTC, 61% have a diagnosis of dementia.
480,600 Canadians have dementia. 2.8 million Canadians are caregivers.
Multiple factors inform the decision to move into long-term care.
This decision is part of the caregiving trajectory, for many caregivers.
Q2
“Are CR/CG trajectories modified by psychosocial and income support interventions?”
Data Sources
Literature Review
Q1
"Is there any difference between the length of caregiving trajectory for caregivers in the intervention and those who are not, given they have the same initial income?"
Ducharme et al. (2012) Substantive Theory.
Andersen et al. (1995) Behaviour Model.
Ajzen et al. (1991) Theory of Planned Behaviour.
Challis and Hughes (2003) and Kuluski et al. (2012).
The Consequences of Supporting Low-Income Dementia Caregivers
Natalie Warrick, PhD Student
METHODS
Sample
ANALYSIS
Caregiver Characteristics
Specific focus on caregiver burden to understand the complexities underlying caregivers’ decisions to move care recipients (CR) into long-term care (Gaugler et al., 2011; Mittelman et al., 2006; Roth et al., 2001; Chrisp et al. 2012).

System-level Determinants
System level limitations that might precipitate a caregivers’ decision to move their care recipient into long-term care (Kuluski et al., 2012; Joling et al., 2012).
Theory
Quasi-Experimental

Nonequivalent Group Design
Pretest and post-test for treatment and comparison
Secondary Analysis of Admin Data
Data linkages using client BRN

Toronto Central CCAC RAI-HC/CHRIS
Ontario Home Care Administration System (OHCAS)
ED Notification/ NACRS
Alzheimer Society CSP Survey



385 CSP dyads from subset of TC CCAC Seniors Enhanced Care (SEC)

9632 Non-CSP dyads from SEC

CR : Medium and high levels of medical instability and cognitive impairment, patients at risk for LTC placement.

CG : Low-income (postal code and caregiver report)

Baseline: Independent t-tests and Chi-square

Mediation Analyses

Internal validity threats:
Biases due to selection differences.
Interaction of selection-maturation.
Attrition - CR/CG will be excluded if participation in intervention < 2 months.
Regression might occur because some members were selected because of high MAPLe/risk.

External validity threats:
Interaction of testing and intervention.
Techniques to Address Selection Bias
Setting
Macro Policy Question
"How does Ontario home care policy impact on low income caregivers LTC decision-making?"
Variables
Limitations
Community-dwelling Caregiver/Care recipient dyads residing in Toronto, Ontario Canada who are on the roster of the Toronto Central CCAC Seniors Enhanced Care Program over the time period from 2011 to 2014.


Independent Variables (IV)
Time-invariant: Treatment Group, CG (i.e. Age, Income, Emotional Status), CR (i.e. Age, CHESS, MAPLe).
Time-dependent: Caregiver willingness to increase ADL/IADL Support, continue caring, ED visits.
Primary covariate: CPS
Dependent Variable (DV) Outcome measures
Time to Long-term Care Placement from date of enrollment (2011- 2014).
Propensity score matching (with stratification by MAPLe)




Tests for NEGD
Questions?

Suggestions for improvement?
Q&A and Suggestions
Survival Analysis
Q2 Cox Proportional Hazards

Q1 Reliability-corrected ANCOVA
Internal validity strengths: controls for main effects of history, maturation,testing, instrumentation.

Large sample size of dataset increases likelihood of achieving power.

3 Year time horizon.
Strengths
Full transcript